ICHV Division of Pharmacy Division of Oncology

1. Work with cytotoxic drugs : overview of different hospitals’ wards in Valais, Switzerland Buchmann S 1, Obrist R 2, Marty S 1 Institut Central des Hôpitaux Valaisans, SION, Switzerland 1Division of Pharmacy 2Division of Oncology sophie.buchmann@ichv.ch 32nd European Symposium on Clinical Pharmacy VALENCIA 29.10 – 1.11.2003 ICHV Division of Pharmacy Division of Oncology Background and objective Evaluation of the work with cytotoxic drugs in different hospitals’ wards in Valais, Switzerland. Because of the geographic dissemination of those hospitals (fig.1), all depending on the Central Pharmacy, which is halfway located, there is no centralised cytotoxics’ preparation existing yet. The aim of this study is to identify sources of errors (fig.2) and try to reduce potential for chemotherapy-related mistakes. Design Initially literature's review and guidelines on the subject and visits in two Universitary Hospitals working with a centralised cytotoxics’ preparation at the Pharmacy. Then, local evaluation with a check-list (fig.3) concerning prescription, drugs’ order at the Central Pharmacy, preparation and finally treatment’s administration. Setting 10 wards working with cytotoxic drugs in different hospitals in Valais, Switzerland. Main outcome measures Comparison of the different wards’ results with the literature's recommendations, guidelines and with the way of work in the two visited Universitary Hospitals. (fig.4) 50 km Fig. 1 : Location of the six regional hospitals in Valais Fig. 2 : Example of dangerous drugs’ order received at the Central Pharmacy Fig. 3 : Check-list’s first page Results Most of the divergences from the literature's recommendations have been found at the stages of prescription and preparation of cytotoxic drugs. The prescriptions are not necessarily given in a procedure form and are not always clear enough for the nursing staff. Safety precautions during the preparation of cytotoxic drugs are not always applied in optimal way. Contamination’s risks for both the nursing staff and the prepared drugs exist. Medicines’ orders at the Pharmacy and treatment’s administration are the stages with a lower risk of problems. Fig. 4 : Example of results’ analysis table Conclusions The study shows problems within the process which could generate serious complications for patients and for the nursing staff. The improvements that a Central Pharmacy can propose, in order to decrease the risk of mistakes are : standardization of procedures for chemotherapy for all the prescribers, including all informations that the nursing staff needs, plus local support for the preparation of cytotoxic drugs. Eventually centralisation of cytotoxic drugs’ preparation at the Central Pharmacy, considering difficulties ensuing geographical distribution of hospitals. The implication of the clinical pharmacist in such a process may be essential to reduce risks with the cytotoxic drugs.